1. Field of the Invention
The present invention concerns the construction of a laparoscopic specimen retrieval shoehorn (xe2x80x9cLSRSxe2x80x9d). An LSRS combines the features and advantages of a laparoscopic specimen extraction port (xe2x80x9cLSEPxe2x80x9d) with those of an endoscopic specimen retrieval bag device (xe2x80x9cERBDxe2x80x9d). More specifically, the present invention concerns the construction of a device that facilitates removal of a specimen extracted from a patient during laparoscopic surgery, among other types of surgery.
2. Description of Related Art
As illustrated in FIG. 11, during a typical abdominal laparoscopic surgery, a surgeon makes four or so small (typically about 2 cm) incisions 10 in the abdominal wall 20 of the patient. The surgeon positions a trocar 22 (shown in FIGS. 15 and 16) into an axial hole 26 in a laparoscopic port 30 to facilitate insertion of the port 30 into the incision 10. After inserting the trocar 22 and port 30 through the incision 10, the surgeon removes the trocar 22 to allow insertion of surgical instruments (e.g., grasping instrument 80) into the abdominal cavity 40 through the axial hole 26 in the port 30. The surgeon repeats this procedure for each of the four or so required ports 30.
To simplify the figures and focus on the functional structures of the laparoscopic port 30 and trocar 22, FIGS. 11-14 illustrate simplified views of the conventional laparoscopic port 30. It is to be understood, however, that in reality, conventional laparoscopic ports 30 and trocars 22 are typically shaped as shown in FIGS. 15 and 16. Similar types of simplified views are used to illustrate the present invention. Nonetheless, as would be appreciated by one of ordinary skill in the art, the present invention will, in practice, have a shape similar to the laparoscopic port 30 and trocar 22 illustrated in FIGS. 15 and 16.
The surgical instruments that are inserted through the laparoscopic port 30 typically include a video camera that enables the surgeon to visualize the surgical procedure. Variously sized surgical ports 30 are designed to be used with variously sized instruments. Typical instruments require surgical ports 30 with axial holes 26 having 5 mm inside diameters. As is discussed in greater detail below, endoscopic specimen retrieval bags (xe2x80x9cendo-bags(trademark)xe2x80x9d) typically are inserted through ports 30 that have holes 26 with 10 mm inside diameters and 12 mm outside diameters.
During laparoscopic surgery, the abdomen is insufflated with carbon dioxide to distend the abdominal cavity 40 (creating pneumoperitoneum) and allow for better visualization of the surgical operation. Each port 30 includes a flapper valve 45 (see FIGS. 15 and 16) that opens to allow the surgeon to insert an instrument therethrough and automatically closes when the instrument is removed so as to prevent the loss of pneumoperitoneum.
During laparoscopic surgery, it is often necessary to extract a specimen 50 such as a gall bladder from the abdominal cavity 40 of the patient. As illustrated sequentially in FIGS. 11-14, using a conventional specimen extraction technique, the surgeon inserts an endo-bag 60 through one of the ports 30 and positions the endo-bag 60 using an endo-bag handle/controller 70. As illustrated in FIG. 11, after the specimen 50 has been surgically detached from the patient, the surgeon uses a surgical grasping instrument 80, which is inserted into the abdominal cavity 40 through a separate port 30, to place the specimen into the open endo-bag 60. As illustrated in FIG. 12, the surgeon pulls a xe2x80x9cpurse stringxe2x80x9d 90 of the endo-bag 60 to synch down the open end of the endo-bag 60, thereby securely enclosing the specimen 50 within the endo-bag 60. As illustrated in FIG. 13, the surgeon then removes the port 30 through which the endo-bag 60 was inserted, leaving the purse string 90 extending through the incision 10. This unfortunately often causes loss of pneumoperitoneum, leading to impaired visualization of the specimen 50 during the extraction process. The surgeon thereafter attempts to pull the endo-bag 60 and specimen 50 out of the abdominal cavity 40 through the incision 10.
Unfortunately, as illustrated in FIG. 14, it is frequently difficult for the surgeon to extract the specimen 50 and endo-bag 60 through the relatively small incision 10. As the surgeon pulls the endo-bag 60 through the incision 10, most of the plastic endo-bag 60 easily pulls through the incision 10 with the specimen 50 bunching in the bottom of the endo-bag 60 in the abdominal cavity 40 (as shown in FIG. 14). Such bunching results in a variety of deleterious effects. In one example, the surgeon may resort to exerting a strong pulling force on the endo-bag 60, causing the endo-bag 60 and/or the surgical specimen 50 to rupture. Such a rupture might spread infectious, bilious, and/or even cancerous material in the abdominal wall 20 and cavity 40. Alternatively, the surgeon may resort to extending his/her initially relatively small port incision 10. Expanding the incision 10 deleteriously increases postoperative pain, increases surgical blood loss, increases the risk of future dehiscence (opening) of the incision and/or herniation of the abdominal contents through the expanded incision 10, and reduces or eliminates the advantages of laparoscopic surgery. Furthermore, the complications that often accompany the specimen 50 extraction procedure add significant operating room and anesthetic time to the surgery, which greatly increases the cost of the procedure to the hospital and the patient.
In summary, while prior art laparoscopic ports 30 and procedures(s) (as outlined above in connection with FIGS. 11-14) have proven effective, for the most part, in laparoscopic surgery, the prior art ports 30 available (and, therefore, the procedure(s) used in connection with those ports 30) may lead unnecessarily to complications. This has resulted in a need for an improved port and/or procedure to lessen the occurrence of such complications.
In addition, as may be apparent from the foregoing discussion, laparoscopic surgery relies upon coordination between several instruments, the port 30, the endo-bag handle/controller 70, the endo-bag 60, and the surgical grasping instrument 80. This coordination, while performed routinely and successfully during laparoscopic surgery, is complex and calls out for a solution.
One aspect of the present invention, therefore, provides an improved laparoscopic instrument that reduces surgery time and post-operative recovery time.
An additional aspect of the present invention provides a laparoscopic instrument that substantially prevents a specimen from bunching in an endo-bag during extraction of the specimen from a patient.
A further aspect of the present invention provides a laparoscopic instrument that reduces the risk of rupturing the specimen or endo-bag during extraction of the specimen from a patient.
A further aspect of the present invention provides a laparoscopic instrument that reduces the risk of spreading infectious, bilious, and/or cancerous material into the patient""s abdominal cavity and/or incision.
Another aspect of the present invention is to provide an LSRS. The LSRS has a primary shaft, where the primary shaft includes a rearward portion, an intermediate portion, and a forward portion. The forward portion is radially-enlarged relative to the intermediate portion. A secondary shaft is slidably disposed within the primary shaft. The secondary shaft has an endo-bag attached thereto. A sheath, with expanded and contracted positions, is slidably disposed around the primary shaft. The sheath has a holding ring disposed radially-outwardly from the intermediate portion of the primary shaft. The holding ring is adapted to slide relative to the intermediate portion. The holding ring is disposed at a rear end of the sheath. A plurality of circumferentially-spaced prongs are disposed at a forward end of the sheath. The prongs have forward ends positioned adjacent to the radially-enlarged, forward portion of the primary shaft when in the contracted position. The forward ends of the prongs expand radially-outwardly relative to the primary shaft when the sheath is in the expanded position. During transition from the contracted to the expanded position, the radially-enlarged forward portion expands the prongs radially-outwardly.
A further aspect of the invention involves the construction of an LSRS where the prongs are shoehorn shaped.
Another aspect of the invention provides an LSRS where the prongs overlap one another at least partially when in the contracted position.
An additional aspect of the present invention provides an LSRS with a sheath having an intermediate shaft connecting the holding ring to the rearward ends of the prongs.
Still another aspect of the invention concerns the forward portion of the primary shaft, which is radially-enlarged relative to an inside surface of the holding ring such that the forward portion prevents the holding ring from sliding forwardly beyond the forward portion.
One additional aspect of the invention provides for an LSRS with a releasable holding mechanism to selectively secure the holding ring to the intermediate portion of the primary shaft when the sheath is in the contracted position.
An aspect of the invention also concerns an LSRS where rotation of the holding ring relative to the primary shaft disengages the holding mechanism to allow the sheath to be manipulated into the expanded position.
One further aspect of the invention concerns the holding mechanism for an LSRS. The holding mechanism has a forwardly-facing surface defined by the holding ring, a notch on an inside surface of the holding ring, the notch extending rearwardly from the forwardly-facing surface, and a protrusion extending from an outer surface of the intermediate portion of the primary shaft. A rearward edge of the protrusion is disposed in front of the forwardly-facing surface when the sheath is in the contracted position to prevent the sheath from moving rearwardly relative to the primary shaft. Rotation of the holding ring relative to the primary shaft aligns the protrusion with the notch, thereby allowing the protrusion to move through the notch and the primary shaft to move rearwardly relative to the holding ring to permit the sheath to be manipulated into the expanded position.
Another aspect of the invention is directed to an LSRS where the forward portion of the primary shaft comprises a radially-outwardly-tapering outer surface.
Still another aspect of the invention concerns an LSRS where each prong includes a forward tip that has inside and outside surfaces, and wherein the inside surface of the forward tip tapers radially-outwardly so that, when the sheath is in the contracted position, the outwardly-tapering inside surface of the forward tip of each prong adjoins the outwardly-tapering outer surface of the forward portion of the primary shaft.
Aspects of the invention also encompass an LSRS where the prongs comprise a flexible material that expands radially-outwardly during expansion of the laparoscopic specimen retrieval shoehorn.
Still other aspects of the present invention are directed to an LSRS where the prongs comprise at least one of plastic and PVC.
Additional aspects of the invention concern an LSRS where an indentation is formed on a surface of the sheath to define a folding line for the prongs.
Another aspect of the invention encompasses an LSRS where the prongs are tinted a color easily distinguishable from tissue or are partially radio-opaque.
One further aspect of the invention concerns an LSRS where the secondary shaft further includes a wire attached thereto. An endo-bag is disposed one the wire. The wire is pre-conditioned to form a loop.
One further aspect of the invention provides an LSRS where the wire has a cross-section selected from a group comprising rectangular, circular, elliptical, and ovoid.
Still another aspect of the invention is directed to an LSRS where the primary shaft and the secondary shaft define deployed and non-deployed positions with respect to one another. When in the deployed position, the endo-bag is disposed exteriorly to the primary shaft.
A further aspect of the invention encompasses an LSRS where the primary shaft and the secondary shaft define deployed and non-deployed positions with respect to one another. When in the deployed position, the wire and the endo-bag are disposed exteriorly to the primary shaft.
Still another aspect of the present invention is directed to an LSRS including a purse string attached to the endo-bag so that, after insertion of a specimen thereinto, the purse string may close an open end of the endo-bag.
One further aspect of the invention provides for an LSRS where the endo-bag is detachably connected to the secondary shaft such that, when the purse string is pulled, the endo-bag detaches from the secondary shaft and its open end is closed thereby.
Additional and/or alternative objects, features, aspects, and advantages of the present invention will become apparent from the following description, the accompanying drawings, and the appended claims.